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General NPI Number Information
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NPI Number | 1265501449
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Entity Type | Organization
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Legal Business Name | BETTER LIFE 4 YOU, L.L.C.
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7700 OLD BRANCH AVE SUITE B105
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City | CLINTON
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State | MD
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Zip | 20735-1628
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Country | US
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Telephone | 301-807-8046
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Fax | 240-823-6000
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Provider Business Mailing Address
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Address Line | PO BOX 328
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City | UPPER MARLBORO
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State | MD
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Zip | 20773-0328
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Country | US
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Telephone | 301-807-8046
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Fax | 240-823-6000
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. IVORY M ROBERTS CLARKE
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Credential | PH.D.
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Telephone | 301-807-8046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 04258
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License Number State | MD
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